ORIGINAL ARTICLE
Voice and swallowing after partial laryngectomy: Factors influencing outcome
Matteo Alicandri–Ciufelli, MD, Alessia Piccinini, MD, Alberto Grammatica, MD,* Andrea Chiesi, MD, Giuseppe Bergamini, MD, Maria Pia Luppi, SLT,
Federica Nizzoli, SLT, Angelo Ghidini, MD, Sauro Tassi, MD, Livio Presutti, MD
Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy.
Accepted 30 November 2011
Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/hed.22946
ABSTRACT: Background. The purpose of this study was to assess the
factors influencing swallowing and phonatory results after partial
laryngectomy.
Methods. We carried out a medical chart review of patients who
underwent partial laryngectomies between June 2003 and November
2010, focusing on functional outcomes.
Results. Thirty-two patients were enrolled. No statistically
significant difference was found in the comparison of phonatory
outcomes of patients with preservation of both arytenoids; the
results of the Yanagihara classification were significantly different
(p ¼ .015) in patients with an atypical neoglottis; radiotherapy
statistically significantly influenced only the mean fundamental
frequency (p ¼ .035). The type of partial laryngectomy does not
INTRODUCTION
Partial laryngeal surgery causes important alterations to
the normal anatomy of the upper digestive tract, particu-
larly in its intersection with the airways. Postoperative
sequelae affecting swallowing and phonation are always
present, and recovery of adequate function can be diffi-
cult to achieve.
Despite the fact that these interventions have been used
for a number of decades, in the recent English-language
literature, there is a paucity of studies investigating the
functional outcomes from an endoscopic, acoustic, per-
ceptual, and self-assessment point of view. Moreover,
various parameters have been evaluated, lacking definite
guidelines in the evaluation of swallowing and phonatory
results.1 Articles present in the literature only focus on
single types of laryngectomy from a functional outcome
point of view, without comparing different types of par-
tial laryngeal operations.2–4 Furthermore, single factors
influencing the functional outcomes such as some ana-
tomical structure preservation (eg, arytenoid cartilage),
postoperative conformation of the neoglottis of patients,
or time after surgery were only rarely considered, and the
*Corresponding author: A. Grammatica, Otolaryngology Department,
University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy.
E-mail: albertogrammatica@libero.it
The authors received no financial support or funding for this study.
seem to affect the deglutition results; radiotherapy statistically
significantly affected the dysphagia score (DS; p ¼ .03),
penetration aspiration (p ¼ .02), and MD Anderson Dysphagia
Inventory (MDADI; p ¼ .02).
Conclusion. Horizontal supraglottic laryngectomy and supracricoid
partial laryngectomy give the same swallowing results. The presence of
both arytenoids does not influence the final outcome compared to
patients in whom only 1 arytenoid is preserved. Postoperative
radiotherapy only influences the swallowing function. V C 2012 Wiley
Periodicals, Inc. Head Neck 00: 000-000, 2012
KEY WORDS: partial laryngectomy, voice function, swallowing
function, laryngeal cancer, logopedic rehabilitation
analysis of single factors influencing the final outcomes
were evaluated on a single type of laryngectomy or com-
pared to total laryngectomies.
With the advances in radiotherapy and chemotherapy in
treating head and neck cancer and consequent organ pres-
ervation protocols, the attention of the scientific commu-
nity will be increasingly focused on the functional results
of partial laryngeal surgery. In fact, due to similar sur-
vival rates between surgery and radiotherapy in most
stages of this pathology, the challenge for surgery will be
to demonstrate acceptable functional results in terms of
voice and swallowing, so as to maintain and justify a role
in the therapy of laryngeal cancer.
The purpose of the present study was to assess the
main factors influencing swallowing and phonatory results
after supracricoid partial laryngectomy and horizontal
supraglottic laryngectomy. Knowledge of the factors that
most influence the functional outcome could help the sur-
geon in technique selection and anatomical structure pres-
ervation, which should be accurately balanced in every
patient with the objective of a radical removal of the
neoplasm.
MATERIALS AND METHODS
Between June 2003 and November 2010, 176 patients
underwent partial laryngectomies at the Ear, Nose, and
Throat Department of the University Hospital of Modena.
In the event of a favorable clinical course and without
complications, on the seventh postoperative day, patients
HEAD & NECK—DOI 10.1002/HED MONTH 2012 1

TABLE 1. Dysphagia score.
Score Symptoms
1 No symptoms.
2 Rare cough during liquid food deglutition.
3 Frequent cough during liquid food deglutition.
Rare cough during solid food deglutition.
4 Frequent cough during solid and liquid food deglutition.
5 Frequent cough not related to food
introduction. Inadequate food intake.
6 Recurrent aspiration pneumonia.
were evaluated by a speech therapist before starting pho-
natory and deglutitory rehabilitation. Rehabilitation ther-
apy ended at the discharge of the patient unless there
were complications or delays in adequate functional
recovery.
For patients who reside in Modena and its province, it
was possible to ensure an adequate and continuous
follow-up of the phonatory and swallowing performances
with a timing not defined in advance, but based on clini-
cal issues and patient performance regarding swallowing
and phonation.
All patients underwent phoniatric evaluation consisting
of: (1) clinical history interview; (2) dysphagia score
(DS) evaluation (Table 1), a scale already used and
described in an earlier article,5 consisting of quantifying
the patient's dysphagia grade by assigning a score based
on symptoms reported; (3) performance status scale for
head and neck cancer (PSS-HN) compilation, testing the
normalcy of diet and the ability to eat in public, grading
on a scale from 0 to 100,6 and a single result was
recorded; (4) MD Anderson Dysphagia Inventory
(MDADI): a validated dysphagia-specific quality-of-life
questionnaire assessing the emotional, physical, and func-
tional consequences of deglutition impairment7; (5) Voice
Handicap Index-10 (VHI) to assess a patient's self-per-
ceived emotional, physical, and functional status relative
to their voice dysfunction8; (6) spectroacoustic voice ex-
amination (Kay Electrics CSL model 4300B) according
to the SIFEL protocol9 recording a message containing
the word "AIUOLE'' and the vowel "a.'' Each spectroa-
coustic examination was evaluated using Yanagihara's
classification of dysphonia (1967).10 Finally, the funda-
mental frequency of the vocal signal was established for
each patient giving the mean fundamental frequency
(MF); (7) the maximum phonatory time (MPT; normal
value >10 seconds) of the vowel "a'' was evaluated and
assessed for each patient, executing the evaluation 3 con-
secutive times and recording the maximum result; and (8)
instrumental evaluation of the patient, using flexible en-
doscopic evaluation of phonatory and swallowing
(FEES). All of the procedures were executed by the same
ENT specialist and a video of each patient was recorded
on the same digital support Atmos MediaStroboscope.
During FEES, boluses of various consistencies (liquid
and gelatinous colored water) were used to evaluate the
correct deglutition process or the eventual anatomic and
functional alterations. Data were evaluated using a pene-
tration aspiration (PA) scale modified for partial laryn-
2 HEAD & NECK—DOI 10.1002/HED MONTH 2012
ALICANDRI–CIUFELLI ET AL.
gectomy (Table 2), already used and described in an ear-
lier article,5 and the score was assessed for each patient.
In particular, during the FEES for patients undergoing
supraglottic horizontal partial laryngectomies, the parame-
ters examined were: vocal fold mobility, anatomic con-
formation of the residual laryngeal tissue, and vibration
of the residual laryngeal structure. For patients under-
going other partial laryngectomies (cricohyoidoepiglotto-
pexy [CHEP], cricohyoidopexy [CHP], and tracheohyoi-
doepiglottopexy [THEP]), the parameters examined were:
presence of 1 or both arytenoids, motility of the cricoary-
tenoid unit, type of neoglottic competence (ie, typical or
atypical), and presence of vibrating structure. A retro-
spective medical chart review of these patients was con-
structed for the period between November 2010 and Feb-
ruary 2011.
The inclusion criteria for the present study were:
patients operated on by partial laryngectomy, at least 6
months after operation so as to attain adequate achieve-
ment and stabilization of vocal performance at the end of
speech therapy after surgery, and patients undergoing a
full course of speech therapy performed during hospitali-
zation and postoperatively at our department.
The exclusion criteria were as follows: patients with
pneumopathies with a reduction in vital lung capacity,
patients who underwent surgery for Vox implants or
laryngeal injection for phonetic and deglutitory rehabilita-
tion purposes, and patients with neurologic events occur-
ring in the postoperative period. The phonatory and swal-
lowing comparisons were performed in the following
groups: preservation of 1 arytenoid versus preservation
of both arytenoids, typical versus atypical neoglottis,
patients undergoing radiotherapy versus patients not
undergoing radiotherapy, and horizontal supraglottic par-
tial laryngectomy versus supracricoid/supratracheal partial
laryngectomy.
Statistical considerations
The Mann–Whitney test was used to compare the non-
parametric variables (DS, PA, PSS, MDADI), a t test was
used for parametric variables (MPT, VHI, MF), and Pear-
son's chi-square test was used to compare the results of
Yanagihara's classification.
TABLE 2. Modified penetration-aspiration scale.
Score Criteria
1 Material does not enter the airway.
2 Material enters the airway, contacts the neoglottis,
stimulates cough reflex, and is ejected completely.
3 Material enters the airway, contacts the neoglottis,
stimulates cough reflex, and is not completely ejected.
4 Material enters the airway, passes below the
neoglottis, stimulates cough reflex, and is
ejected completely.
5 Material enters the airway, passes below the
neoglottis, stimulates cough reflex, and is not
completely ejected.
6 Material enters the airway, passes below the
neoglottis, and no effort is made to reject.
VOICE AND SWALLOWING AFTER PARTIAL LARYNGECTOMY

Abbreviations: MPT, maximum phonatory time; VHI 10, Voice Handica Index-10; MF, mean fundamental frequency; DS, Dysphagia score; PA, Penetration Aspiration Scale; PSSHN_nd, performance status scale for head and neck cancer normal diet; PSSHN_ep, per-
formance status scale for head and neck cancer eating in public; PSSHN_us, performance status scale for head and neck cancer understanding sounds; MDADI_G, MD Anderson Dysphagia Inventory_global; MDADI_E, MD Anderson Dysphagia Inventory_emotional;
We also evaluated the correlation between the phona-

MDADI_P‡
tory and swallowing parameters and the age of the

0.155
0.772
0.121
0.678
0.318
patients and time after surgery; for this correlation, we

0.29
used Pearson's correlation coefficient.
SPSS Statistics software, version 17.0, was used for sta-

MDADI_F‡
tistical analyses.

0.331
0.904
0.565
0.564
0.303
0.485
RESULTS

MDADI_E‡
From the retrospective medical chart review, data for
36 patients were retrieved. Four patients were excluded

0.17
0.61
0.11
0.52

0.88
0.6
from the study because they had undergone a previous
Vox Implants (Bioplasty BV, Hofkamp 2, 6161 DC

MDADI_G‡
Geleen, The Netherlands) injection for rehabilitative pur-
poses. Therefore, 32 patients (31 men and 1 woman)

0.13
0.45

0.24
0.51
0.36
0.9
were enrolled in the study (age range, 50–85 years; mean
age, 65 years).

PSSHN_us‡
The types of laryngectomy were as follows: 9 supra-
glottic horizontal partial laryngectomies, 21 supracricoid

0.638
0.537
0.921
0.013
0.274
0.725
laryngectomies with CHEP, 1 supracricoid laryngectomy
with CHP, and 1 supratracheal laryngectomy with THEP.

PSSHN_ep‡
The results of the spectroacoustic analysis conducted on
the entire sample gave an average MPT of 9.31 seconds

0.226
0.501

0.485
0.042
0.433
(SD 64.49; range, 3–20 seconds), and the distribution of

0.6
values was as follows: 19.44%
5 seconds, 41.66% >5
seconds and <10 seconds, and 38.88% 10 seconds.

PSSHN_nd‡
The mean fundamental frequency for the entire sample

0.392
0.221
0.025
0.586
0.986
0.878
was 150.47 Hz (SD 640.10 Hz; range, 66–236 Hz).
The overall distribution of the patients in Yanagihara's
classification was: 44.44% class IV; 19.44% class III;
0.322
0.432

0.077
0.834
0.169
PA‡

0.02
19.44% class II; and 16.66% class I.
The mean VHI was 11.83 (SD 68.39), with a distribu-

MDADI_F, MD Anderson Dysphagia Inventory_functional; MDADI_P, MD Anderson Dysphagia Inventory_Physical; RT, radiation therapy.
tion of 8.33% >27 and <40 (severe); 25%
26 and >13
0.403
0.894

0.479
0.861
0.281
DS‡

0.03
(moderate); 63.88%
13 and >0 (mild); 2.77% ¼ 0
(normal).
YANAGIHARA†

From the analysis of swallowing function, the results

0.106
0.015
0.349
p < .001
0.245
0.179
for the entire sample were as follows: the mean DS was
1.75 (SD 61.05), with a distribution of 8.33% ¼ 4;
19.44% ¼ 3; 11.11% ¼ 2; and 61.11% ¼ 1. The mean
value of the Penetration Aspiration Scale was 1.19 (SD
0.771
0.399
0.035
p < .001
0.202
0.203

60.52), with a distribution of 5.55% ¼ 3; 8.33% ¼ 2;

MF*

and 86.11% ¼ 1.
Regarding the quality of life, the analysis of the PSS-
HN on the whole group gave the following average val-
VHI10*

0.212
0.772

0.337
0.845
0.47

0.02

ues: Normal diet ¼ 92.50 (SD 612.04); Eating public ¼

Note: Bold face numbers represent the statistical positive value of our findings.

87.50 (SD 620.27); and Understandability of speech ¼

77.78 (SD 616.67).
0.309
0.962
0.036
0.095
0.816
MPT*

0.97

The mean values of the subdirectory of MDADI were:

TABLE 3. Results of statistical analysis (p values).

global (G) ¼ 76.67 (SD 625.97); emotional (E) ¼ 40.80

Supraglottic laryngectomies vs supracricoid

(SD 617.23); functional (F) ¼ 44.33 (SD 614.51); and

Analysis conducted only on supracricoid laryngectomies.
Atypical vs typical neoglottic competence§

Chi-square of Pearson (A vs B: superiority comparison).

physical (P) ¼ 77.64 (SD 618.19).

Mann–Whitney test (A vs B: superiority comparison).

The results obtained from statistical analysis performed

on the single groups of patients (1 or 2 arytenoids, typi-
cal/atypical neoglottis, radiotherapy/no radiotherapy, or
* T test (A vs B: superiority comparison).
1 arytenoid vs 2 arytenoid§

supracricoid/supraglottic resection) are summarized in

Correlation Coefficient of Pearson.

Table 3.
Time from surgery¶

DISCUSSION
No RT vs RT

Phonatory outcomes
Supracricoid partial laryngectomies result in resection
Age¶

of the glottic and paraglottic space together with the thy-

roid cartilage. So the neoglottic sphincter is composed of
†
‡
¶
§

HEAD & NECK—DOI 10.1002/HED MONTH 2012 3


anatomic structures left after the destructive surgery:
anteriorly, the tongue base and the suprahyoid epiglottis
(only in CHEP and THEP), and posteriorly, 1 or both
cricoarytenoid units. In these patients, phonation is
guaranteed by approximation of these structures: 1 or
both arytenoids move forward meeting with the tongue
base and the suprahyoid epiglottis. In CHP and tracheo-
hyoidopexy, the epiglottis is fully removed, so 1 or both
cricoarytenoid units join with the tongue base. On the
other hand, in horizontal supraglottic laryngectomy,
resection preserves the glottis and phonation occurs
through vibration of the vocal folds. Clearly, based on
our results, by preserving the vocal folds as in horizontal
supraglottic laryngectomy, all of the phonatory outcomes
were significantly better and also the statistical analysis
has shown a significant difference in a comparison of the
results of supraglottic and supracricoid laryngectomies.
As we have already explained, in supracricoid laryng-
ectomies, the neoglottic sphincter is composed of anatom-
ical structures preserved after the destructive surgery and
phonation is guaranteed by the approximation of the
tongue base, the cricoarytenoid units, and, if preserved,
the epiglottis. But in some patients in our sample, we
have found that neoglottis formation can occur from atyp-
ical anatomic features. The results of statistical analysis
have shown that the kind of neoglottic competence does
not affect the MPT, MF, and VHI. Only the results of
Yanagihara's classification are significantly influenced (p
¼ .015). In fact, in our sample, we found that the patients
with atypical neoglottic competence were distributed
mostly within classes 2 and 3 (40% and 60%, respec-
tively), none in class 4, whereas 70.6% of patients with
typical neoglottic competence were distributed in class 4.
This could be due to anomalous positioning of the epi-
glottis or involvement of the lateral pharyngeal wall in
the sphincteric and vibratory function of the neoglottis. In
this way, atypical neoglottis formation seems to guarantee
adequate functional outcome in terms of vocal perform-
ance. In the literature, there are no studies on the atypical
neoglottis. Only 1 study published recently describes the
different types of atypical neoglottis in patients under-
going supracricoid laryngectomies.11 In fact, this article
describes how the epiglottis and arytenoids could articu-
late in various shapes to participate in sphincteric and
phonation function. In this study, the phonatory out-
comes, in particular, MF, VHI, and MPT (11, 6, and 12,
respectively), seem to be comparable with the outcomes
of our series.
Concerning supracricoid partial laryngectomy, in our
analysis, no statistically significant difference was found
in the comparison of phonatory outcomes of patients with
preservation of 1 or both arytenoids. In fact, based on our
results, the preservation of both arytenoids does not sig-
nificantly impact the voice quality of patients. In cases
where there is a doubt about the oncologic radicality of
resection, this could be an important decisional factor for
the surgeon. Comparing our results with the literature,
Weinstein et al12 have also attempted to compare the
phonatory outcomes in patients with 1 or both arytenoids.
In fact, in that work, the authors described the videostro-
boscopic features of the mucosal wave when 1 or both
arytenoids were present, but the series was too limited to
disclose any statistical correlation with phonatory out-
come. In another study, So et al13 analyzed the phonatory
4 HEAD & NECK—DOI 10.1002/HED MONTH 2012
ALICANDRI–CIUFELLI ET AL.
outcomes of supracricoid partial laryngectomies. MPT
was not significantly affected by arytenoid removal sug-
gesting well-tolerated recovery of the glottal closure after
removal of 1 arytenoid and reconstruction of the
neoglottis.
As reported in the literature,14 radiotherapy after supra-
cricoid partial laryngectomy could be associated with a
negative influence on functional outcome and a direct
correlation has been demonstrated between radiotherapy
dose and complication rate after larynx preservation ther-
apy. In the literature, adverse reactions correlated with
radiotherapy are certainly well known and may result in
unexpected functional disturbance which may cause per-
sistence or worsening of the complaints about phonatory
function.15 Analyzing our sample, the results of MPT and
VHI in patients undergoing radiotherapy were comparable
with the results for patients in whom no radiotherapy was
performed and no statistically significant difference was
found between the 2 groups (p ¼ .962; p ¼ .772). On the
other hand, the increase in MF found in patients under-
going radiotherapy was statistically significant (p ¼ .035)
(180 Hz vs 148 Hz in patients in whom no postoperative
radiotherapy was performed). This result could be
explained by increased rigidity of the structure as a result
of fibrosis after radiotherapy causing a loss of elasticity
of the mucosa and, therefore, an increase in the funda-
mental frequency. In a recent study, Pellini et al16 com-
pared a group of patients with untreated laryngeal cancer
versus a group with laryngeal recurrence after radiother-
apy and both groups were treated by supracricoid partial
laryngectomy. No statistically significant difference in
phonatory function was reported, and the mean MPT in
the group of patients undergoing partial laryngectomy for
untreated laryngeal cancer was 7.7 versus 8.2 in the
group of patients with recurrence after radiotherapy.
Moreover, our analysis revealed that the correlation
between phonatory outcome and the age of the patient
and time after surgery was not statistically significant.
Concerning the time after surgery, our results are also
confirmed by a study3 in which the purpose was to com-
pare the evolution of the perceptual and acoustic parame-
ters at 6 and 18 months postoperatively. Those authors
did not find a statistically significant modification of ei-
ther the perceptual or the acoustic parameters between 6
and 18 months postoperatively. This might be related to
the fact that voice improvement might have stabilized at
6 months after surgery, resulting in no further improve-
ment after the sixth postoperative month.
Swallowing outcomes
Swallowing is a fundamental outcome for quality of
life in patients undergoing supracricoid partial laryngec-
tomy and its postoperative impairment is the most com-
mon short-term and long-term complication. When con-
sidering patients operated by partial open laryngectomy,
we must consider an anatomy that is completely changed
and that can react to the surgical modifications in various
ways therefore affecting postoperative outcome. In the lit-
erature, as with the phonatory results, there is a great var-
iability in swallowing outcomes from good to poor and
this could also be influenced by the mode of investigation
by each institution.2–4 Most authors, particularly in the
VOICE AND SWALLOWING AFTER PARTIAL LARYNGECTOMY
past, measured swallowing function by calculating the
nasogastric feeding tube removal timing and/or permanent
gastrostomy rate,17–19 and some authors adopted the PSS-
HN cancer questionnaire to test the quality of life of
patients.17,20 Only recently has videofluoroscopic exami-
nation been adopted as a tool for the study of swallowing
disorders by analyzing bolus transit and, to our knowl-
edge, only 2 articles have discussed this technique.4,15 In
our study, we investigated the swallowing outcome based
on fibrolaryngoscopic and FEES evaluation, testing the
premature spillage of food, laryngeal motility and laryn-
geal aspiration of each patient, and with the compilation
of various questionnaires investigating the objective (PA
and DS) and subjective (PSS-HN and MDADI) swallow-
ing competence. Compared to videofluoroscopy, FEES
has advantages in terms of safety in the case of high risk
of inhalation. It guarantees visual feedback for the patient,
it can be performed on an outpatient basis even in
patients who cannot be transferred to a radiology center,
and, moreover, it ensures the absence of repeated expo-
sure to radiation. The disadvantages are the problematic
evaluation of bolus management in the oral cavity, the
challenging visualization during the act of deglutition,
close to the base of tongue and on the rear wall of the
pharynx, and the difficult evaluation of microaspiration or
food penetration close to the act of deglutition.
Statistical analysis did not find any correlation for DS,
PA, and MDADI, and the swallowing part of PSS-HN
between the group in which both arytenoids were pre-
served versus the group with preservation of only 1 aryte-
noid; so preservation of both arytenoids does not improve
the final outcome of a partial laryngectomy as was
observed by Bron et al17 in a series of 17 patients under-
going supracricoid partial laryngectomy in which aryte-
noid resection statistically did not diminish the restoration
of swallowing. Zacharech et al19 reported a complete res-
toration of swallowing function after supracricoid partial
laryngectomy in all 10 patients studied (in 4 of 10
patients, both arytenoids were spared). Although the num-
ber of patients examined was small and no statistical
analysis was performed between the number of arytenoids
and the swallowing postoperative performance, the
authors stress how a good swallowing function was
reached in 100% of cases. These findings contradict those
of Laccourreye et al21 who stressed the importance of
preservation of both arytenoids to guarantee a better post-
operative functional result and avoid complications. In
addition, Lima et al22 stated how the incidence of compli-
cations after supracricoid partial laryngectomy is higher
with arytenoid resection observing a longer time to tra-
cheostomy and PEG tube removal compared to patients
in whom both arytenoids were spared.
Regarding the anatomic type of the glottis, we did not
find a statistically significant correlation between the type
of neoglottis (atypical or typical) and any of the swallowing
parameters considered. As has previously been explained
regarding phonatory outcome, an atypical or typical neo-
glottis could also function normally for deglutition parame-
ters, ensuring an optimal sphincteric valve and avoiding
aspiration pneumonia or premature food spillage.11
Interestingly, in our cohort, the type of partial laryngec-
tomy did not seem to affect the deglutition results; in
fact, swallowing outcomes for DS, PA, MDADI, and
PSS-HN are quite similar when comparing horizontal
supraglottic laryngectomy with supracricoid/supratracheal
laryngectomies and no statistically significant differences
were found between the 2 groups. From the English-lan-
guage literature consulted, the authors did not find any
articles in which the various types of laryngectomy were
studied, only articles focusing on 1 type of laryngectomy
or comparing supracricoid partial laryngectomy versus
total laryngectomy.15 So, to the best of our knowledge,
this seems to be the first article to evaluate and compare
various types of partial laryngectomy (horizontal supra-
glottic laryngectomy, supracricoid partial laryngectomy)
from a functional point of view.
In our study, the only factor that negatively influences
swallowing function seems to be radiotherapy. Radiother-
apy statistically significantly affects the DS (p ¼ .03), PA
(p ¼ .02), and MDADI (p ¼ .02). In patients undergoing
radiotherapy, often fibrosis, scarring, mucositis, edema,
erythema, and tenderness of target tissues are present as
well as neighboring healthy tissue. These adverse reac-
tions may result in unexpected functional disturbances of
involved muscular, mucosal, and neurovascular tissue that
can cause a severe impairment of the swallowing mecha-
nism. Radiotherapy after supracricoid partial laryngec-
tomy has been reported to be associated with a negative
effect on the functional outcome and a direct correlation
has been demonstrated between radiotherapy dose and
complication rate after larynx-preservation therapy.14
More recently, in a study comparing a group of patients
with untreated laryngeal cancer versus a group with laryn-
geal recurrence after radiotherapy and with both groups
treated by supracricoid partial laryngectomy, Pellini
et al16 reported no statistically significant difference in
swallowing function with a definitive restoration of satis-
factory deglutition in 89% of patients who did not receive
radiotherapy and in 82% of patients irradiated.
In our study, a statistically significant correlation was
not seen between the age of patients and the DS (p ¼
.86), PA (p ¼ .83), or MDADI global questionnaire (p ¼
0.05) except for the eating in public component of the
PSS-HN. This could be explained by a lower compliance
of elderly patients to participate in social life because of
their age and also the stigma caused by the operation and
probably because of worries over swallowing in public
places. Functional swallowing outcomes after supracricoid
partial laryngectomy associated with the age of patients
(over 65 years) have already been investigated in previous
studies by Alajmo et al,23 who reported a high rate of
aspiration pneumonia and swallowing dysfunction, stating
that supracricoid partial laryngectomies are not advisable
for elderly patients. Naudo et al24 reported temporary
grades 1 to 2 of aspiration, according to the scale adopted
by Leipzig,25 of 1 to 4 months duration in 23.4% (44 of
188 patients operated by supracricoid partial laryngec-
tomy) with a statistically significant correlation with
increased age. Moreover, grade 3 aspiration (pneumonia
with aspiration) occurred in 8.5% of patients and, in this
case, a correlation with increased age was also seen. On
the other hand, in the past, Laccourreye et al26 reported
21.7% of aspiration pneumonia after supracricoid partial
laryngectomy, stating that age on its own should not be
HEAD & NECK—DOI 10.1002/HED MONTH 2012 5

considered as a deterrent for supracricoid partial laryn-
gectomy completion, and more recently, this was con-
firmed by Schindler et al27 in a study which showed that
age did not significantly impact swallowing function.
Finally, our analysis did not find any correlation
between the results of PA, DS, PSS-HN, and MDADI
questionnaires and time after surgery, showing that the
postoperative time from the sixth month onward does not
affect swallowing function.
CONCLUSION
The present investigation shows how horizontal supra-
glottic laryngectomy and supracricoid partial laryngec-
tomy give the same swallowing results, obviously differ-
ing in terms of phonatory results. The presence of both
arytenoids compared to patients in whom only 1 aryte-
noid was preserved does not seem to influence the final
outcome. A further factor that seems to modify results is
radiotherapy, which influences only the swallowing func-
tion without affecting the phonatory results. Other factors
such as age of the patient and time after surgery do not
seem to influence the final outcome of both swallowing
and phonatory results, but a lack of statistical significance
of some data may be due to the small sample size and
limited statistical power of some of the calculations,
although the data obtained are in every way consistent
with the clinical impressions and views of the authors.
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